Prevention of postoperative wound infections: to cover up?

Gowns, gloves, and masks have been a familiar sight in operating rooms since the beginning of the previous century. Colors and shapes have changed over the years, but the principle of covering body surfaces to prevent the spread of microorganisms from the surgical team to the surgical wound has remained unchanged. The notion that surgical-wound infection is the result of contamination of the wound with microorganisms during the operation goes back even further, almost 150 years, to Lister, who was the first surgeon to realize the meaning of the studies of Pasteur. He introduced disinfection of hands and instruments with carbolic acid and emphasized that bacteria in the air should be killed with carbolic acid sprayed above the wound. In those days, the surgical team wore normal clothes (Figure). Since Lister's time, disinfectants for the skin of the patient and the hands of the surgeon, the layout of operating rooms to ensure clean air, and the wearing of gowns, masks, and gloves all have improved. With the introduction of antibiotic prophylaxis at the end of the 1960s, the frequency of surgical-site infections (SSIs) has fallen to its present rates. These developments have enabled surgeons to perform extensive surgical procedures relatively safely.